The management of sinusitis in patients infected with the human immunodeficiency virus (HIV).

As the Human Immunodeficiency Virus (HIV) has extended its influence across the United States, otolaryngologists have been increasingly called upon to manage its various head and neck manifestations. Sinusitis is a very prevalent, yet difficult, management problem in this patient population. The pathophysiology of sinusitis in this setting relates to altered helper T-lymphocyte function, an abnormal inflammatory response as well as increased IgE-mediated inflammation. Chronic HIV-related sinusitis is often due to Pseudomonas aeruginosa, Staphylococcus aureus, or anaerobic bacteria, and empiric antibiotic therapy must include these potential pathogens. Early cultures can facilitate organism-specific antibiotic therapy. Aggressive treatment with decongestants, topical nasal steroids, mucoevacuants and occasionally antihistamines should be included at maximal tolerated doses. When medical therapy fails, surgical drainage can be a safe and effective management option. Appropriately directed medical, and occasionally surgical, therapy can lead to a dramatic clinical response and provide an improved quality of life in this patient population.